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Maternity > Module 5 > Flashcards

Module 5 Flashcards

1
Q

Components of PostPartum Assessment

A
  • Vitals -Emotional
  • Fundus - Lochia
  • Bladder - Perineum
  • Breasts -Cardiovascular
  • Pain - Bowels
  • Extremeties
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2
Q

Involution

A

Changes of the reproductive organs to return to prepregenancy state. After birth
Mostly Uterus
Can take 5-6 weeks

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3
Q

Subinvolution

A

Failure of the uterus to return to prepregnancy state after 6 weeks

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4
Q

Common Causes of Subinvolution

A
  • Infection

- Retained fragments of placenta

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5
Q

Signs of Subinvolution

A
  • Bigger then expected Fundal Height after 6 weeks
  • Continued Lochia Rubra
  • Pelvic pain
  • Heaviness
  • Fatigue
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6
Q

Nursing care for Subinvolution

A
  • Teach about normal changes to expect
  • Report fever, persistent pain, Red lochia , foul smelling vaginal discharge
  • Teach how to palpate fundus and what is normal

If admitted to hospital:

  • Assist with medical therapies
  • Providing analgesics
  • Comfort measures.
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7
Q

Fundus

A
  • Should be felt midline at or below umbilicus
  • Grapefruit size mass
  • Should descend at predictable rate
  • Descend 1cm/day
  • no longer palpable after 10 days
  • Full Bladder can displace fundus
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8
Q

Afterpains

A
  • Intermittent contractions similar to mestrual cramps
  • Decreases in 48hrs
  • More common in women who have had more then 1 pregnancy
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9
Q

Why does breastfeeding sometimes cause afterpains

A
  • Releases oxytocin causing the uterus to contract.
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10
Q

Lochia

A
  • Vaginal discharge after delivery
  • Composed of lymph, blood and endometrial tissue
  • Menstraul or fleshy odor
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11
Q

3 types of Lochia

A
  • Lochia Rubra
  • Lochia serosa
  • Lochia Alba
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12
Q

Lochia Rubra

A
  • Red
  • Composed mostly of blood
  • Lasts 3 days after birth
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13
Q

Lochia Serosa

A
  • Pink
  • Blood and mucous
  • 3rd - 10th day after birth
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14
Q

Lochia Alba

A
  • Clear, Colorless or white
  • Mostly Mucous
  • 10th-21st day after birth
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15
Q

Components of Lochia Assessment

A
  • Character
  • Color
  • Odor
  • Consistency
  • Clots Number + Size
  • Amount
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16
Q

Scant Amount

A

Less then 5cm soiled

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17
Q

Light Amount

A

Less then 10 com soiled

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18
Q

Moderate Amount

A

Less then 15 cm Soiled

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19
Q

Large Amount

A

Larger then 15 cm soiled or full pad in 2 hours

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20
Q

Excessive Amount

A

Pad saturated in 15 min

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21
Q

Lochia Nursing Considerations

A
  • Assess fundus at routine intervals
  • Explain purpose of fundal assessment and interventions
  • Teach how to assess fundus
  • Message soft or boggy fundus to promote contractions
  • Urinary status: full bladder could prevent contractions
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22
Q

Normal Lochia Sequencing teachings and what to report

A
  • Foul Smelling Lochia
  • Lochia Rubra that lasts more then 3 days
  • Unusually Heavy Flow
  • Lochia that turns bright red after already progressing to serosa or Alba
  • Large clots, specially if followed by lochia Rubra.
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23
Q

Cervix

A
  • Soft immediately after birth
  • Regains muscle, not as tight as prepregnancy state
  • 2-3 days to shorten, firm and regain form
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24
Q

Ectocervix

A
  • Bruised with lacerations

- Can cause infections

25
Q

Vagina

A
  • Rugae dissapear and vaginal walls become smooth to allow for expansion
  • Reappear 3 weeks postpartum
  • Regains most prepregnancy form after 6 weeks
  • Vaginal mucosa thickens when ovarian function reoccurs.
26
Q

Patient Teachings of Vagina

A
  • Safe to resume sex when bleeding stops and episiotomy heals
  • Vagina does not lubricate well before 6 weeks postpartum and longer when breastfeeding.
27
Q

Episiotomy or lacération of Perineum

A
  • Heals within 2-3 weeks
  • Assess for REEDA
  • Vulvar hematoma/bruising
  • Hemmerrhoids worsen from pressure during birthing
28
Q

Nursing Considerations for Perineum Episiotomy

A
  • Cool compress for 1st 24hrs
  • Heat application after 24 hrs (site bath warm packs)
  • Hygenic measures ( peri bottle after each void)
  • Topical medications ( witch hazel, benzocaine, hydrocortisone with promoxine
  • Donut ring pillows for sitting.
29
Q

Normal Blood loss at delivery

A

500 mL vaginal

1000 mL csection

30
Q

Post Partum Bradycardia

A

50-60 BPM

Can last 48 hrs

31
Q

Excess Fluid is excreted by..

A
  • Diuresis ( increased urination)

- Diaphoresis ( profuse perspiration)

32
Q

Diuresis

A

Increased Urination

3L /day

33
Q

Diaphoresis

A

Profuse perspiration
most common at night
last 2-3 days

34
Q

Post Part Blood Values

A
  • Stabilize after 12 days

- Fully stabilized by 8 weeks

35
Q

Coagulation

A
  • Blood Clotting higher during pregnancy/4-6 weeks postpartum
  • Ability to Lyse does not increase
  • Risk of blood clot formation
36
Q

Risks of blood clot formation

A
  • Csection
  • Vericose veins
  • Delayed abulation
  • Venous Stasis
37
Q

Postpartum Blood Clot assessment

A
  • Presence of dyspnea
  • Tachycardia
  • unilateral calf swelling/pedal edema
  • Positive Homans sign
38
Q

Blood Clot prevention Teachings

A
  • Encourage ambulation
  • Rational for prophylactic VTE therapy
  • Encourage use of pneumatic Compression Devices.
39
Q

Heart Rate Assessment

A

Brady cardia is NORMAL

Tachycardia is ABNORMAL

40
Q

Nursing care for Diaphoresis

A
  • Provide frequent showers/sponge baths

- Educate that this is temporary

41
Q

Assessment of Legs for Thrombosis

A
  • Redness
  • Warmth
  • Tenderness to touch
  • Homans sign
42
Q

Teaching for Orthostatic Hypotension

A
  • Assist with ambulation

- Sit at the edge of bed before standing

43
Q

Post Partum Diuresis

A
  • starts within 12 hours postpartum

- up to 3000 mL / 24 hrs

44
Q

What does urinary distention cause

A
  • Can cause excessive bleeding
45
Q

Bladder Assessment

A
  • Distention

- Urination Frequency

46
Q

Urination assessment

A
  • Frequency
  • Color
  • Amount
  • Odor
47
Q

Postpartum Bladder Distention

A
  • Decrease Muscle tone of bladder and ureters
  • Bladder fills quickly but it does not completely empty
  • May not feel urge to void or feel her full bladder
48
Q

Breastfeeding mothers

A
  • Colostrum expressed before lactation

- Tenderness persists for 48 hours after lactation begins

49
Q

Non-Breastfeeding Mothers

A
  • Engorgement resolves and discomfort decreases in 24-36 hours
  • Breast binder or tight bra, ice packs, fresh cabbage leaves, mild analgesics used to relieve discomfort.
50
Q

Breast Assessment

A
  • Size Shape and Symmetry
  • Engorgment
  • Check Nipples for cracks, redness, blisters, size and shape
51
Q

Engorged breast

A
  • Breast is hard, erect and uncomfortable

- Nipple maybe to hard and erect for newborn to grasp

52
Q

Patient teaching for Breasts

A
  • Comfortable bra
  • avoid nipple stimulation if not breast feeding
  • Wash with water to avoid drying effect of soap.
53
Q

Bowels Postpartum

A
  • Normal activity as progesterone levels decrease

- Constipation

54
Q

Bowel Assessment

A
  • Flatus
  • Bowel Sounds
  • Bowel Movement
55
Q

Nursing care for postpartum Bowel

A
  • Encourage fluid
  • Add fibre to diet
  • Ambulate
  • Administer stool softener
56
Q

Homans Sign

A

Calf pain experienced upon dorsiflexion of the foot, indication of thrombophlebitis

57
Q

Emotional Assessment

A
  • Bonding
  • Family Interaction
  • Support
  • Physical contact with newborn
58
Q

BUBBLE-HE

A
  • Breasts
  • Uterus
  • Bladder
  • Bowel
  • Lochia
  • Episiotomy
  • Homans Sign
  • Emotions/Bonding
59
Q

postpartum Blues

A
  • conflicting feelings of joy and emotional let down
  • May feel let down bu overall finds pleasure in life
  • Reassure mom that these are normal feelings and temporary.

Maternity (6 decks)

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